Virginia has until the fall of this year to devise its own benchmark plan for healthcare, or accept by default the benchmarks mandated by the federal healthcare law.
Members of the Virginia Health Reform Initiative Advisory Council have made progress, but continue the laborious task of devising a comprehensive plan.
Since the U.S. Supreme Court has not ruled on the healthcare lawsuit, states must proceed as if the federal law is constitutional. The law mandates a state structure that allows one-stop shopping and subsidies for individuals without coverage to buy insurance if they're between 138 and 400-percent of the federal poverty level.
But as Secretary of Health and Human Resources Bill Hazel explains, the state must decide who sets benchmarks, copays, and what should go into a base package that's still affordable.
"The base problem with the access to healthcare already is the expense," says Hazel. "Now then there's the other problem where if you don't have a benefit and someone needs that benefit, it may be harder for them to get it, so the job is balance."
The Virginia Association of Health Plans has endorsed using anthem's small group PPO as the blueprint for the state's base plan. Once the council makes its decisions, the General Assembly and federal officials will also make adjustments.